NYS Health Initiatives to Improve Population Health Population - - PowerPoint PPT Presentation

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NYS Health Initiatives to Improve Population Health Population - - PowerPoint PPT Presentation

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NYS Health Initiatives to Improve Population Health Population Health Summit II: Bridging Health Care and Population Health Payment and Financing October 28, 2014 Courtney Burke, Deputy Secretary for Health New York State Health

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NYS Health Initiatives to Improve Population Health

Population Health Summit II: Bridging Health Care and Population Health – Payment and Financing

October 28, 2014

Courtney Burke, Deputy Secretary for Health

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New York State Health Initiatives

  • Prevention Agenda
  • Delivery System Reform Incentive Payment (DSRIP)

Program

  • State Health Innovation Plan/State Innovation Model

(SHIP/SIM)

  • Population Health Improvement Program (PHIP)

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Prevention Agenda 2013-2017

  • Goal: Improved health status of New Yorkers and reduction in

health disparities through increased emphasis on prevention in the community and health care settings.

  • Call to action to broad range of stakeholders

to collaborate at the community level: – to assess local health status and needs; – to identify local health priorities; and – to plan, implement, and evaluate strategies for local health improvement.

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Collaborative Leadership

  • Led by ad hoc committee

made up of members of Public Health and Health Planning Council and leaders from public health, health care, business, academia, and community- based organizations.

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Five Prevention Agenda Priorities

  • 1. Prevent chronic diseases
  • 2. Promote a healthy and safe environment
  • 3. Promote healthy women, infants, and children
  • 4. Promote mental health and prevent substance

abuse

  • 5. Prevent HIV, sexually transmitted diseases,

vaccine-preventable diseases, and health care associated infections

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  • Data resources
  • Evidence-based strategies
  • List of DOH contractors by

county and Prevention Agenda priority area

  • Useful for DSRIP Community

Needs Assessment and Population Health interventions

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Resources Available

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  • 1. Integrated Delivery – Creating Performing Provider Systems
  • 2. Project Value Drives

a. Transformation # and types of projects b. # of Medicaid members served (attribution) c. Application quality – speed and scope of implementation

  • 3. Performance Based Payments – Process & Outcome Measures
  • 4. Statewide Performance Matters
  • 5. Regulatory Relief and Capital Funding Available
  • 6. Lasting Change

a. Long-term transformation b. Health system sustainability

Six Key Themes of DSRIP

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MCO* HH #1 HH #2

Other PPS Providers

Other Providers PPSs

ROLE:

  • Insurance Risk Management
  • Payment Reform
  • Hold PPS/Other Providers Accountable
  • Data Analysis
  • Member Communication
  • Out of PPS Network Payments
  • Manage Pharmacy Benefit
  • Enrollment Assistance
  • Utilization Management for Non-PPS Providers
  • DISCO and Possibly FIDA/MLTCP Maintains Care

Coordination

ROLE:

  • Care Management for Health Home Eligibles
  • Participation in Alternative Payment Systems

ROLE:

  • Be Held Accountable for Patient Outcomes and Overall

Health Care Cost

  • Accept/Distribute Payments
  • Share Data
  • Provider Performance Data to Plans/State
  • Explore Ways to Improve Public Health
  • Capable to Accept Bundled and Risk-Based Payments

How The Pieces Fit Together: MCO, PPS & HH

Five Years in the Future

*Mainstream, MLTC, FIDA, HARP & DISCO

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SHIP/SIM Overarching Goals

The SHIP is New York’s overarching vision to integrate and coordinate multiple ongoing initiatives with the goal of

  • ptimal health and well-being for all New Yorkers.

Population Health Goal of the SHIP:

  • “Improve population health through strengthened capacity

and improved screening and prevention through closer linkages between primary care, public health, and community based supports.”

  • 2020 Goal: Achieve top quartile performance among states in

prevention and public health

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State Innovation Model (SIM) Testing Grant

Funding was requested to support the following:

  • Clinical preventive services that have a demonstrated impact
  • n public health goals and that strengthen linkages between

clinical care providers, local public health, and community- based organizations

  • Regionally-based primary care practice transformation
  • Transition to value-based payment
  • Expanding NY’s primary care workforce through innovations in

professional education and training

  • Development of a common scorecard, shared quality metrics,

and enhanced data/analytics

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SHIP/SIM Population Health Public Health Consultants

  • SIM-funded public health consultants (PHCs) will enhance,

promote, and support clinical-community integration working closely with: – Regional population health improvement programs (PHIPs), – SIM-funded practice transformation teams – Medicaid DSRIP Performing Provider Systems

  • PHCs are key to achieving population health by reaching

beyond clinical settings to incorporate community and public health systems

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SHIP/SIM Sustainability

Sustainability will be assured through:

  • Ongoing support of key population health interventions

by DSRIP, prevention agenda, etc.

  • Public and private delivery system transformation (APC)
  • Reimbursement reform to promote payer support of

proven effective services (tobacco cessation)

  • Potential hospital investments in community benefits as

required by the Affordable Care Act

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SHIP/SIM Next Steps

Convene workgroups under a single overarching health innovation coordinating council:

  • Who: External stakeholders selected by NYS with multi-agency

staff support

  • What: Five targeted workgroups with specific goals and
  • bjectives
  • When: Rolling implementation, beginning with health

information technology, convened fall 2014 CHARGE: Create a health policy agenda for 2015 and beyond.

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SHIP/SIM Timeline

  • SHIP submitted to CMMI December 2013
  • SIM testing application submitted July 18, 2014
  • In-person interview for invited states: October 2014
  • Grant award announcement: October 2014
  • Formal implementation: January 2015–December 2018

(48 months) – 2015: Planning – 2016: Implementation – 2017: Evaluation

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PHIP Overview and Objectives

PHIP will promote the Triple Aim—better care, better population health, and lower health care costs—by selecting regional contractors to provide a neutral forum for identifying, sharing, disseminating, and helping implement best practices and strategies to promote population health and reduce health care disparities in their respective regions. PHIP contractors will, within their regions:

  • Support and advance the Prevention Agenda
  • Support and advance the SHIP
  • Serve as resources to DSRIP Performing Provider Systems in

their regions upon request

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PHIP Regions

Tug Hill Seaway Finger Lakes Southern Tier Central NY Mohawk Valley North Country Western NY Capital Region Mid-Hudson NYC Long Island

Preliminary PHIP Regions

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PHIP Contractors

Through a Request for Applications (RFA), NYSDOH has solicited applications for PHIP contractors in 10 regions throughout the state. The Finger Lakes Health Systems Agency (FLHSA) will serve as the PHIP contractor for the Finger Lakes region and will provide technical assistance to the Department that will help support the

  • ther contractors.

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PHIP Stakeholders

PHIP contractors will engage stakeholders, including:

  • Health care consumer and patient advocacy organizations
  • Behavioral health advocacy organizations
  • Disability rights organizations
  • Health, behavioral health and disabilities service providers
  • Rural health networks
  • Insurers and other payers
  • Local public health officials and other local officials
  • Local human service agencies
  • The business community
  • Unions
  • Schools and institutions of higher education
  • Local housing authorities
  • Local transportation authorities

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PHIP Activities

  • Convening key stakeholders within the regions
  • Providing neutral forum for sharing best practices and

innovative population and community health strategies

  • Incorporating strategies to address health disparities including

promoting US DHHS’ National Culturally and Linguistically Appropriate Services Standards in Health and Health Care

  • Utilizing evidence-based patient and community engagement

mechanisms to ensure input from community members and promote consumer engagement

  • Integrating and coordinating activities with other regional

health and human services planning agencies

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PHIP Activities (continued)

  • Collecting outcome, claims, and utilization data to identify local

needs and measure local health system performance

  • Analyzing regional health and health care needs and leading and

coordinating regional initiatives based on data to improve health and achieve high quality and cost effective care

  • Reporting on Prevention Agenda and SHIP metrics across the region

and by specific populations

  • Facilitating and advancing Prevention Agenda priorities in

coordination with local health department and hospital planning activities

  • Providing data and analytics related to a regional workforce strategy

to advance the SHIP and support integrated care delivery

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PHIP Activities (continued)

  • Facilitating and supporting programs that enable health care

professionals to obtain training, coaching, and technical assistance

  • n practice transformation and ways to analyze problems in care

delivery and ways to design and successfully implement solutions

  • Supporting the Prevention Agenda and the SHIP through the

development, implementation, measurement and evaluation of innovative health system strategies designed to address health disparities, promote access to care, development of integrated care delivery systems, community services integration and health workforce development; assure informed decision making by health care consumers; and support health information technologies

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PHIP Timeline

  • August 22, 2014: RFA released
  • October 17, 2014: Application deadline
  • November 14, 2014: Anticipated date of awards
  • December 1, 2014: Anticipated start of contacts
  • January 9, 2014: Anticipated date of PHIP contractor
  • rientation

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Links

For additional information about the Prevention Agenda: http://www.health.ny.gov/prevention/prevention_agenda/2013- 2017/index.htm For additional information about DSRIP: https://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_ reform_incentive_payment_program.htm For additional information about the SHIP: http://www.health.ny.gov/technology/innovation_plan_initiative For additional information about the PHIP: http://www.health.ny.gov/community/programs/population_health_improve ment

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Common Themes

  • Overall shared goal: achieving Triple AIM
  • Collaborative
  • Accountable
  • Focus on local needs and solutions
  • Clinical care improvements
  • Attention to behavioral health
  • Health disparities and social determinants of health

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